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Philippine Institute for Development Studies Surian sa mga Pag-aaral Pangkaunlaran ng Pilipinas
The PIDS Discussion Paper Series constitutes studies that are preliminary and subject to further revisions. They are being circulated in a limited number of copies only for purposes of soliciting comments and suggestions for further refinements. The studies under the Series are unedited and unreviewed.
The views and opinions expressed are those of the author(s) and do not necessarily reflect those of the Institute.
Not for quotation without permission from the author(s) and the Institute.
The Research Information Staff, Philippine Institute for Development Studies 18th Floor, Three Cyberpod Centris – North Tower, EDSA corner Quezon Avenue, 1100 Quezon City, Philippines Tel Numbers: (63-2) 3721291 and 3721292; E-mail: [email protected] visit our website at https://www.pids.gov.ph
Health Practices of Children and Women with Disabilities
DISCUSSION PAPER SERIES NO. 2017-60
Celia M. Reyes, Charina Cecille M. Reyes, and Arkin A. Arboneda
December 2017
Draft as of December 2017
Health Practices of Children and Women with Disabilities1
Celia M. Reyes, PhDa, Charina Cecille M. Reyes, MDb and Arkin A. Arbonedac
a Senior Research Fellow, Philippine Institute for Development Studies b Clinical Asst. Professor, Developmental-Behavioral Pediatrics, University of Maryland c Research Assistant, Philippine Institute for Development Studies
Abstract
Persons with disabilities (PWDs) in the Philippines generally face several difficulties in getting hold of
a much needed medical attention, including transportation and other barriers to access, and financial
difficulties, among others.
This study is an offshoot of the joint project of the Philippine Institute for Development Studies and the
Institute of Developing Economies that focuses on the health conditions of PWDs, both adult women
and children, in Mandaue City and San Remigio, Cebu, Philippines. Using primary data collected
through survey and key informant interviews with various stakeholders, the study highlights the lack of
access to appropriate services for PWDs and that out-of-pocket expenditures on health covers a
significant portion of their income. Some recommendations include the provision of early detection and
intervention, and routine monitoring programs, the expanded utilization of medical and nursing students
in the communities in providing preventive care services, the expanded coverage for medications and
nursing/caregiver support, and the increased training on health care providers and personnel,
particularly in the communities.
Keywords: Philippines, health, health practices, access to health care, person with disability, PWD,
San Remigio, Mandaue City, Cebu
1 This paper will be part of an upcoming PWD book
Draft as of December 2017
1. Introduction
The World Health Organization (WHO) estimates that over a billion people or about 15% of the world’s
population lives with some form of disability; between 110 million (2.2%) and 190 million (3.8%) of
which have significant difficulties in functioning (World Health Organization, 2011). In the Asia and
the Pacific region, the United Nations Economic and Social Commission for Asia and the Pacific
(ESCAP) estimates that one in every six persons in the region have some form of disability (United
Nations Economic and Social Commission for Asia and the Pacific (ESCAP), n.d.). Both WHO and
UNESCAP expect these numbers to increase due to factors, which include an aging population, increase
in chronic health conditions, improved detection and increased incidence of disasters.
In the Philippines, based on the 2010 Census of Population and Housing (CPH), of the 92.1 million
household population in the country, 1,443 thousand persons (1.57%) were identified as having a
disability (National Statistics Office, 2010). As a result of physical, cognitive and/or psychological
limitations, persons with disabilities (PWDs) have been found to have an increased risk of illness
compared to those without a disability and a shorter life expectancy. This is particularly evident in those
whose disability affects activities of daily (ADLs) such as feeding, dressing and washing oneself, and
their mobility (Majer, Nusselder, Mackenbach, Klijs, & Baal, 2011). PWDs have also been found to
have lower school enrollment rates. The increased risk of illness and subsequent need for frequent
medical follow up and hospitalizations result in reduced time spent being educated in school setting or
maintaining meaningful employment. In 2005, the International Disability Rights Monitor (IDRM)
reported that 1 in 5 children with disabilities have never attended school, which is four times higher
than children without disabilities. In addition, only one third of PWDs have received education beyond
the elementary school level (International Disability Rights Monitor, 2005). The lack of educational
opportunities for PWDs contributes to higher unemployment rates. IDRM estimated that 43% of PWDs
in the Philippines were unemployed (International Disability Rights Monitor, 2005). For those who are
employed however, they generally receive earnings below their counterparts without disabilities (Yin,
Shaewitz, & Megra, 2014).
Women with disabilities who are unable to obtain appropriate diagnostic and treatment services may
experience persistent or worsening impairment in their daily functioning and affect their ability to care
for their children. Lack of adequate treatment can result in less opportunities to participate in education
and obtain gainful employment, and can negatively impact the overall quality of life.
In recognition of these issues, the Philippine Institute for Development Studies has collaborated again
with the Institute of Developing Economies (IDE), a semi-governmental agency in Japan engaged in
social science research, to undertake a survey on children and woman with disabilities in Mandaue City
and in the municipality of San Remigio in Cebu, which include their health practices.
This study aims to examine the health practices of women and children with disabilities in Mandaue
City and San Remigio in Cebu. In particular, the paper examines the access of these women and
children to health facilities and the expenses incurred with seeking medical treatment. The issue of
timely detection of disabilities among children is also discussed in this paper.
2. Methodology
This study uses a household-level survey data set containing information of sample PWDs and their
households. Structured questionnaires encoded in tablets using Open Data Kit (ODK) were
administered through face-to-face interviews with the respondents. Each survey team was composed of
PWDs as enumerator and a companion (e.g. member of the PIDS research team or local persons
recommended by the LGU focal persons) as recorder. There were also validation workshops attended
by various stakeholders including the enumerators and recorders, and key informant interviews to
substantiate the initial findings.
Draft as of December 2017
2.1. Sampling design
Study sites
The study population was limited to two areas in Cebu province – one rural and one urban. The selection
of study sites was done in coordination with the Office of the Provincial Social Welfare and
Development. Based on meetings with the focal persons from the said office, the City of Mandaue and
Municipality of San Remigio were selected as the study areas for the survey. The criteria used for
selection were: (a) distribution of women and children with disabilities; (b) cooperativeness of the local
government; (c) availability of PWD enumerators, and; (d) accessibility and safety of the area.
Mandaue City
Mandaue is one of the three highly urbanized cities in Cebu
province that forms the Cebu Metropolitan area. It is located
in the central-eastern region of the province and is bounded
on the north by the municipality of Consolacion, on the east
by the Mactan Channel, and on the west by Cebu City, and
on the south by the Cebu North Reclamation.
The city has 27 barangays with a land area of 3,487 hectares
and a population of 362,654 as of the 2015 census. Mandaue
City’s total revenue in 2014 was PHP 1.35 billion, which
was higher than the previous year’s figure of PHP 1.25
billion. The City also posted an increase in its regular
income from PHP 977 million in 2012 to PHP 1.23 billion
in 2014. On the other hand, the total expenditures of the City
in 2014 was around PHP 995 million, with the local
development fund amounted to PHP 70.9 million. The
biggest expenditure item in 2014 was the maintenance and
other operating expenses (MOOE), which amounted to PHP
675.5 million. This was followed by economic services,
which amounted to PHP 523.6 million, followed by general
public services, with PHP 307.9 million. Expenditure on
social services and social welfare only amounted to PHP
20.4 million. Meanwhile, the City’s real property tax
accomplishment for 2014 was 83 percent and its total expenditures per capita amounted to PHP
3,003.49.
In terms of health facilities, Mandaue City has 27 Barangay Health Stations (BHS), 1 Rural Health Unit
(RHU) located in Barangay Centro (Poblacion), and 9 hospitals, 2 of which are government-owned. In
addition, there are 16 and 3 hospitals in the adjacent cities of Cebu and Lapu-Lapu, respectively.
Table 1. Financial performance and other indicators, Mandaue City
Indicator Value
Income Class First
Number of Barangays 27
Population (2015) 362,654
Financial performance, 2014
Total Revenue PHP 1,359,792,470.75
Revenue Growth 9%
Annual Regular Income PHP 1,229,098,709.63
% Annual Regular Income to Total Revenue 90%
Figure 1. Map of Mandaue City, Cebu
Source: PIDS (http://gis.pids.gov.ph)
Draft as of December 2017
Total Expenditures PHP 995,116,743.26
20% Local Development Fund PHP 70,964,190.18
Actual MOOE PHP 675,529,131.87
General Public Services PHP 307,921,078.37
Education, Culture and Sports/Manpower Development PHP 54,912,493.25
Health, Nutrition and Population Control PHP 15,768,717.15
Housing and Community Development PHP 22,766,545.13
Social Services and Social Welfare PHP 20,391,301.42
Social Services Expenditures PHP 113,839,056.95
Economic Services PHP 523,608,778.57
Real Property Tax Accomplishment (RPTAR) 83%
Total Expenditures per Capita PHP 3,003.49
Health facilities
Number of Barangay Health Stations (BHS) 27 (one per barangay)
Number of Hospitals 9 (2 public, 8 private)
Number of Rural Health Units (RHU) 1 Sources: 2015 Census of Population and Housing, Philippine Statistics Authority (population); Bureau of Local Government
Finance, Department of Finance (financial indicators), and; National Health Facility Registry, Department of Health (health
facilities)
Municipality of San Remigio
San Remigio is a third class municipality located in the
northwestern part of mainland Cebu province. (See Figure 2
for municipal map.) It is bounded on the northwest by Bogo
City, on the southwest by the municipality of Tabogon, and
on the south by the municipality of Tabuelan. It has 27
barangays with a population of 57,557 as of the 2015 census.
In 2014, its total revenue amounted to PHP 100.2 million
while its total expenditure per capita was estimated to be
around PHP 2,000.63 (Table 2). Aside from the MOEE,
which amounted to PHP 60.5 million, other big expenditure
items of San Remigio include the following: general public
(PHP 55.8 million); social services (PHP 34.7 million);
health, nutrition and population control (PHP 13.5 million).
In terms of health facilities, the municipality has 27 BHS (one
for each barangay), and 2 RHUs. The nearest hospital was
located in the adjacent City of Bogo.
Table 2. Financial performance and other indicators, San Remigio
Indicator Value
Income Class Third
Number of Barangays 27
Population (2010) 51,370
Financial performance, 2014 Total Revenue PHP 100,289,793.12
Revenue Growth 16%
Annual Regular Income PHP 93,866,934.25
% Annual Regular Income to Total Revenue 94%
Figure 2. Map of San Remigio, Cebu
Source: PIDS (http://gis.pids.gov.ph)
Draft as of December 2017
Total Expenditures PHP 102,820,597.66
20% Local Development Fund PHP 24,034,662.02
Actual MOOE Amount PHP 60,592,368.56
Actual CO Amount PHP 3,219,933.00
General Public Services PHP 55,837,143.08
Education, Culture and Sports/Manpower Development PHP 4,571,227.17
Health, Nutrition and Population Control PHP 13,560,324.94
Housing and Community Development PHP 12,375,310.00
Social Services and Social Welfare PHP 4,274,062.47
Social Services Expenditures PHP 34,780,924.58
Economic Services PHP 11,024,544.00
Real Property Tax Accomplishment (RPTAR) 5%
Total Expenditures per Capita PHP 2,000.63
Health facilities Number of Barangay Health Stations (BHS) 27 (one per barangay)
Number of Rural Health Units (RHU) 2 Sources: 2015 Census of Population and Housing, Philippine Statistics Authority (population); Bureau of Local Government
Finance, Department of Finance (financial indicators), and; National Health Facility Registry, Department of Health (health
facilities)
Sampling frame
The sampling frames used in this study are the PWD lists provided by the Office of the Mayor of San
Remigio and the Office of the Social Services of Mandaue City. The lists contain 1,289 and 2,889
PWDs as of 2015 in San Remigio and Mandaue City, respectively. Both lists contain basic information,
including the complete name, sex, address, date of birth, marital status, and type of disability. The PWD
list in Mandaue City contains basic information such as complete name of the PWD, type of disability,
date of birth, complete address, sex, and PWD identification number. The PIDS research team also
sought the assistance of the Provincial Social Welfare Office in validating the PWDs listed in Mandaue
City and San Remigio. The following additional information were asked during the validation visits:
employment, livelihood, membership in organization(s), highest educational attainment as well as
information on whether the PWD is currently in school or not.
The study population refers to all adult women and children with disabilities in San Remigio and
Mandaue City who are included in the PWD lists (i.e. those who are registered and have a PWD ID,
and/or those who have become beneficiaries of government programs at least once). Ideally, the study
population should have been all the adult women and children with disabilities in the said areas,
including those who did not receive any assistance from the government. Unfortunately, such registry
has not been available. The 2015 Census of Population could have been a good sampling frame, both
in terms of comprehensiveness and timeliness, but has not been publicly available as of this writing.
Sampling scheme
The study adopted a (single-stage) stratified random sampling scheme in selecting the sampling units,
which are adult women and children with disabilities.2 A sample size of 200 was equally divided into
two study domains (i.e. Mandaue City and San Remigio each has a total of 100 samples).
Each study was divided into clusters of barangays based on geographical location and total number of
eligible PWD population (adult women and children). The selected cluster in Mandaue City, which
accounts for 25% of the total eligible population, covers barangays in the southeastern part, namely:
Cambaro, Looc, Opao, Umapad and Paknaan. All these barangays are classified as urban. On the other
hand, the selected cluster in San Remigio, which accounts for 50.7% of the total eligible population,
covers barangays in the northern/central part, namely: Argawanon, Lambusan, Lawis, Maño, Sab-a,
2 Since the study would also conduct a household-level analysis, each PWD sample should represent only a single
household.
Draft as of December 2017
San Miguel, Tambongon, Toong, and Victoria, all of which are rural barangays. However, three
barangays in the selected cluster in San Remigio (Sab-a, San Miguel and Victoria) were not covered
and replaced based on the advice of the LGU focal person.
In order to ensure that there are enough number of samples of adult women and children with disabilities
in the analysis, the sample requirements of 100 were equally divided into adult women and children
(i.e. 50 adult women and 50 children per domain). The sample size requirements per type of PWD were
further allocated among the four types of impairment considered in this study, namely: mobility, visual,
hearing, and development/psychosocial. In order to make sure that each type of impairment (particularly
the mobility, visual and hearing) would be well represented, the equal allocation scheme was used
instead of proportional allocation. The three major types of impairment—mobility, visual and hearing—
had 13 samples each, while the remaining 11 were allocated to development and psychosocial
disabilities. Thus, there were three stratification variables used in the sampling scheme, namely: study
domains (Mandaue City and San Remigio), type of respondent (adult women and children) and type of
impairment (mobility, visual, hearing, and development/psychosocial), resulting in a total of 8 (= 2 x
4) strata. The figure below shows the number of required samples per stratum by domain.
Figure 3. Study domains, strata, and the required sample size per level
Within each stratum, simple random sampling was employed to select the sample households, taking
into account the required sample size per stratum. Moreover, the planned number of samples differ from
the actual number of interviewed respondents due to several reasons like incorrect classification of
impairment, and unavailability even after repeated visits. Replacements were done but the study team
made sure of the similarity of the replacements to those being replaced.
Strata
Study domains
Cebu Province
200
Urban
(Mandaue City)
100
Cluster of barangays
Adult women with disabilities
50
Mobility
13
Visual
13
Hearing
13
Development/ Psycho-social
11
Children with disabilities
50
Mobility
13
Visual
13
Hearing
13
Development/ Psycho-social
11
Rural
(San Remigio)
100
Cluster of barangays
Adult women with disabilities
50
Mobility
13
Visual
13
Hearing
13
Development/ Psycho-social
11
Children with disabilities
50
Mobility
13
Visual
13
Hearing
13
Development/ Psycho-social
11
Draft as of December 2017
2.2 Statistical analysis
Descriptive analysis was used in profiling and examining the difference between respondents belonging
in different groups in terms of study area and type of impairment. This paper focuses on the health
module of the survey questionnaire. The study will mainly look on the access of PWDs to PhilHealth
(particularly for adult women), illnesses experienced during the past 12 months, frequency of visit and
distance to the nearest health facility, type of health facility visited, reasons for visiting/not visiting a
health facility, and health-related expenses, among others.
3. Key findings from the survey
The study covered a total of 1,031 adult women and 823 children with disabilities.3 In Mandaue City,
around half of the respondents were from Barangays Paknaan and Umapad. In San Remigio, majority
of the respondents (65.5%) were located in Barangays Argawanon, Maño, and Tambongon. Of the total
respondents, majority are mobility-impaired (39.7%) followed by those with development/psychosocial
impairment (28.7%). There are survey respondents with multiple disabilities; however, only the
impairment listed in the sampling frame is considered in the discussion. The distribution by type (adult
women or children), disability, and location is shown below.
Table 3. Distribution of PWD respondents, by study area and type of impairment
Respondent Type
Mandaue City
Mobility Visual Hearing Development/
Psychosocial Total
Adult Women 372 140 104 140 756
Children 208 60 88 288 644
Total 580 200 192 428 1,400
San Remigio
Mobility Visual Hearing
Development/
Psychosocial Total
Adult Women 98 73 50 54 275
Children 59 40 31 50 179
Total 157 113 81 104 454
All Sites
Mobility Visual Hearing
Development/
Psychosocial Total
Adult Women 470 213 154 194 1,031
Children 267 100 119 338 823
Total 737 313 273 532 1,854 Source of basic data: PIDS-IDE PWD Survey, July 2016
3.1. Children with Disabilities
In Mandaue City, almost half of children respondents (44.7%) belong to the development/psychosocial
group. On the other hand, the mobility group comprises 32.8% of the total children respondents in San
Remigio.
In terms of specific medical conditions, the leading conditions among the mobility-impaired were
cerebral palsy (23.1% in Mandaue City; 13.3% in San Remigio) and congenital lower limb defect
(23.1% in Mandaue City; 26.7% in San Remigio). Majority of children with cerebral palsy in Mandaue
City have the spastic type (66.7%) while the remaining 33.3% have the ataxic type. Those in San
Remigio, on the other hand, do not know the specific type of cerebral palsy that they have. Meanwhile,
most of those with congenital lower limb defect have affected lower leg (either one or both foot). Only
12.3% of the total respondents, all from San Remigio, have both of their legs (above the knee) affected.
3 This is equivalent to a total of 206 samples – 103 adult women and 103 children with disabilities.
Draft as of December 2017
There are also significant proportion of respondents who have polio (15.4% in Mandaue City; 6.7% in
San Remigio). Almost all of them (50% in Mandaue City; 100% in San Remigio) have experienced
paralysis and/or muscle weakness, commonly on the legs and right arm. Moreover, none of the children
have experienced post-polio syndrome. Other conditions specified among the mobility impaired were
upper limb defects, dislocated joints, and scoliosis.
For the visually impaired, majority are only partially blind. The most common cause for visual
impairment is lens disease (41.7% in Mandaue City; 12.5% in San Remigio). On the other hand,
majority of the hearing impaired were partially deaf.
For those with development/psychosocial impairment, 59.3% have intellectual disability, 21.3% have
psychosocial disability, and 19.4% suffer from other conditions. The three most common conditions,
on the average, are learning disabilities (i.e. slow learners), epilepsy, and toxic psychosis.
Table 4. Distribution of PWD children respondents, by study area, type of impairment and specific conditions
Impairment/Condition Mandaue City San Remigio All Sites
N % N % N %
Mobility
Spinal cord injury 0 0.0 8 13.3 8 2.9
Cerebral palsy 48 23.1 8 13.3 56 20.9
Polio 32 15.4 4 6.7 36 13.5
Lower limb amputation 16 7.7 4 6.7 20 7.5
Congenital lower limb defect 48 23.1 16 26.7 64 23.9
Stroke 0 0.0 4 6.7 4 1.5
Other conditions 96 46.2 20 33.3 116 43.3
Visual
Partially blind 55 91.7 37 93.8 92 92.5
Totally blind 5 8.3 2 6.3 7 7.5
Hearing
Partially deaf 54 61.5 18 57.1 72 60.4
Totally deaf 34 38.5 13 42.9 47 39.6
Development/Psychosocial
Intellectual disability 185 64.3 15 30.8 200 59.3
Mental retardation 41 14.3 0 0.0 41 12.2
Down syndrome 0 0.0 8 15.4 8 2.3
Learning disabilities 103 35.7 8 15.4 111 32.7
ADHD 21 7.1 0 0.0 21 6.1
Other conditions 62 21.4 0 0.0 62 18.3
Psychosocial disability 82 28.6 34 69.2 117 34.6
Disordered mood 21 7.1 4 7.7 24 7.2
Epilepsy 41 14.3 11 23.1 53 15.6
Organic mental disorders 0 0.0 4 7.7 4 1.1
Toxic psychosis 21 7.1 8 15.4 28 8.4
Other conditions 0 0.0 8 15.4 8 2.3
Other conditions 21 7.1 0 0.0 21 6.1 Source of basic data: PIDS-IDE PWD Survey, July 2016
In terms of educational attainment, there are more children with disabilities who are at school in
Mandaue City (91.5%) compared to San Remigio (79.4%). In Mandaue City, all children with visual
impairment and development/psychosocial disabilities have attained at least preschool education while
almost one-fourth (23.1%) of the mobility impaired have no formal education. On the other hand,
children with mobility and visual impairments in San Remigio have attained higher levels of education
compared to the other two disabilities.
Draft as of December 2017
Figure 4. Percentage distribution of PWD children, by educational attainment, study area and type of impairment
Source of basic data: PIDS-IDE PWD Survey, July 2016
Access to health services
Almost all of the children with disabilities got sick during the past 12 months from the date of interview
(June to July 2017), with San Remigio having a higher proportion of children who got sick (87.3%)
than Mandaue City (60.5%). Also, children with development/psychosocial disabilities have the highest
proportion of getting sick among the four types of impairment. However, only a small percentage of
those who got sick (an average of 15.5% out of the 66.3% who got sick) have access to PhilHealth.
Figure 5. Percentage distribution of PWD children who got sick within the past 12 months and who are covered
by PhilHealth, by study area and type of impairment
Source of basic data: PIDS-IDE PWD Survey, July 2016
The most common cause of sickness are common cough, colds, flu and/or fever. In both study sites,
around 20% of children have experienced PWD-related diseases. Other illnesses specified by the
respondents were hyperacidity, sore eyes, loose bowel movement, and skin diseases, among others.
23.1
7.7 8.513.3 12.5
28.6 30.8
20.6 20.9
5.013.1
4.511.1
7.7
8.3
7.7
7.1
7.5
6.712.5
30.8
13.57.5
10.0
5.7
10.6
8.8
53.8
75.0
46.2
78.665.8
53.3
62.5 57.1
38.5
51.9
53.7
70.0
49.0
72.7 62.8
15.4 16.7
38.5
14.318.2
26.8
12.5 14.3 14.017.9 15.0
32.2
12.217.3
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
MI VI HI DPSI Total MI VI HI DPSI Total MI VI HI DPSI Total
Mandaue City San Remigio All Sites
No formal education Preschool Elementary High School
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
MI VI HI DPSI Total MI VI HI DPSI Total MI VI HI DPSI Total
Mandaue City San Remigio All Sites
Got sick With PhilHealth
Draft as of December 2017
Figure 6. Percentage distribution of PWD children who got sick during the past 12 months, by type of illness,
study area and type of impairment
Source of basic data: PIDS-IDE PWD Survey, July 2016
Of those who got sick, an average of 63.2% of children have visited a health facility, with Mandaue
City having a higher proportion (68.2%) compared to San Remigio (50.8%). This is mainly due to the
greater presence of health facilities in the cities compared to the rural municipalities. Among the types
of disability, those with development/psychosocial impairment usually visit a health facility when they
got sick.
Table 5. Percentage distribution of PWD children who got sick during the past 12 months and have visited a
health facility, by study area and type of impairment Disability Mandaue City San Remigio Total
Mobility 66.7 26.7 51.5
Visual 50.0 53.3 52.2
Hearing 57.1 60.0 58.0
Development/Psychosocial 72.7 80.0 73.8
Total 68.2 50.8 63.2 Source of basic data: PIDS-IDE PWD Survey, July 2016
Private hospitals (43.8%) and clinics (29.3%) were the most common types of health facility visited by
children who got sick in Mandaue City. On the other hand, PWD children in San Remigio who got sick
often visited Barangay Health Centers or the lone RHU/Health Center/City Health Office located in the
Poblacion. There are also a significant proportion of respondents who visited private hospitals and
clinics which are located in the nearest city/municipality (i.e. Bogo City); some even went to provincial
public hospital/s located in Metro Cebu.
9.1
5.3
7.8
3.8
83
.3
75
.0
71
.4
54.5
64
.7
93
.3
93
.3
80
.0
90
.0
90
.6
87
.1
86
.9
74
.1
59
.7
72
.1
16
.7
50
.0
9.1
12
.0
6.7
2.5
12
.9
17
.5
7.8 9
.3
16
.7
25
.0
14
.3
18
.2
17
.7
13
.3
13
.3
20
.0
20
.0
15.9
15
.4 17
.4
16
.1 18
.4
17
.2
50
.0
25
.0
28
.6
9.1
22
.4
13
.3
10
.0
5.6
31
.1
17
.4 19.5
9.2
17
.6
0
10
20
30
40
50
60
70
80
90
100
MI VI HI DPSI Total MI VI HI DPSI Total MI VI HI DPSI Total
Mandaue City San Remigio All Sites
Common non-communicable diseases Common coughs, cold, flu, fever Injury, cut, wound, burn PWD-related diseases Others
Draft as of December 2017
Table 6. Percentage distribution of PWD children respondents who got sick during the past 12 months, by type of
health facility visited, study area and type of impairment
Type of Health Facility Visited
Mandaue City
Mobility Visual Hearing Development/
Psychosocial Total
Municipal Hospital/City
Hospital
0.0 0.0 0.0 12.5 7.7
RHU/Health Center/City Health
Office
25.0 50.0 75.0 12.5 23.3
Barangay Health Center 25.0 100.0 0.0 25.0 25.3
Private Hospital 75.0 0.0 25.0 37.5 43.8
Private Clinic 25.0 0.0 0.0 37.5 29.3
San Remigio
Mobility Visual Hearing
Development/
Psychosocial Total
Public Provincial Hospital 25.0 12.5 33.3 12.5 18.4
Public District Hospital 0.0 12.5 0.0 0.0 3.1
Municipal Hospital/City
Hospital
0.0 37.5 0.0 0.0 9.4
RHU/Health Center/City Health
Office
50.0 37.5 33.3 50.0 44.1
Barangay Health Center 0.0 50.0 33.3 50.0 37.4
Private Hospital 0.0 12.5 0.0 25.0 12.8
Private Clinic 25.0 12.5 33.3 12.5 18.4
Others 0.0 0.0 33.3 0.0 5.5
All Sites
Mobility Visual Hearing
Development/
Psychosocial Total
Public Provincial Hospital 4.9 8.3 10.9 2.0 4.2
Public District Hospital 0.0 8.3 0.0 0.0 0.7
Municipal Hospital/City
Hospital
0.0 24.9 0.0 10.5 8.1
RHU/Health Center/City Health
Office
29.9 41.7 61.4 18.4 28.1
Barangay Health Center 20.1 66.8 10.9 28.9 28.1
Private Hospital 60.3 8.3 16.8 35.5 36.7
Private Clinic 25.0 8.3 10.9 33.6 26.8
Others 0.0 0.0 10.9 0.0 1.3 Source of basic data: PIDS-IDE PWD Survey, July 2016
Children with disabilities in San Remigio travel significantly longer distances compared to those in
Mandaue City due to the lack of facilities and personnel (i.e. nurses, doctors) and the absence of higher
level health facilities within the municipality. They often go to Vicente Sotto Memorial Medical Center
(VSMMC) located in Cebu City, which is around 108 kilometers or 3.5 hours from the municipal hall.
According to the respondents, VSMMC has the facilities and specialized personnel who can cater to
the specific needs of PWDs (e.g. rehabilitation center, doctors who can prescribe specialized
medicines). Another most commonly visited health facility by respondents in San Remigio is the
provincial hospital in Bogo City (around 8 kilometers or 15 minutes from San Remigio Municipal Hall).
By type of disability, those with visual impairment in San Remigio travel the farthest to visit a health
facility (generally either to a public provincial hospital, private hospital or private clinic) mainly due to
PWD-related diseases. On the other hand, the farthest that children with development/psychosocial
impairment travel is to visit a private hospital due to common coughs/cold/flu/fever and [excessive]
vomiting.
Draft as of December 2017
Table 7. Distance of the nearest health facility visited by PWD children who got sick during the past 12 months,
by study area and type of impairment (in kilometers)
Disability Mandaue City San Remigio Total
Mobility 6.38 4.50 6.01
Visual 0.93 31.79 21.42
Hearing 6.38 19.34 10.62
Development/Psychosocial 2.27 12.13 3.82
Total 3.63 16.73 6.64 Source of basic data: PIDS-IDE PWD Survey, July 2016
Despite longer distances, PWD children in San Remigio go to health facilities more frequently
compared to those in Mandaue City. Among the four disabilities, respondents with mobility impairment
(particularly those with polio) in Mandaue City and children with development/psychosocial disabilities
(particularly those with epilepsy and toxic psychosis) mostly visited a health facility.
Table 8. Frequency of visit to a health facility by PWD children who got sick during the past 12 months, by study
area and type of impairment
Impairment Mandaue City San Remigio Total
Mobility 4.5 2.3 4.1
Visual 3.0 4.4 3.9
Hearing 2.5 4.7 3.2
Development/Psychosocial 1.9 9.5 3.1
Total 2.6 6.0 3.4 Source of basic data: PIDS-IDE PWD Survey, July 2016
Regardless of the type of illness experienced within the reference period, medicines took up the bulk
(around 60%) of medical expenses incurred by children with disabilities in both study areas. This is true
especially for development/psychosocial impairments who requires maintenance mind drug medicines.
Another significant health expense is transportation. In Mandaue City, the mobility-impaired have the
highest average cost incurred for travel. Although health facilities are within the city, barriers to
transportation, particularly for the mobility-impaired, incur additional costs (e.g. tips given to the driver
for accompanying the PWD in going in and out of the vehicle, or in loading wheelchairs and other
assistive devices in the vehicle). In San Remigio, aside from the aforementioned barriers to
transportation, distance to the health facility incur additional costs to the PWDs.
Cost for therapy and check-up is quite low in both study areas. This is because PWD children typically
go to public health facilities such as Barangay Health Stations and Rural Health Units (as shown in
Table 6) wherein services are offered for free up to a minimal amount.
Draft as of December 2017
Figure 7. Health expenses of PWD children during the past 12 months, by study area and type of impairment
Source of basic data: PIDS-IDE PWD Survey, July 2016
Since many were going to public health facilities, the average out-of-pocket expenditure for healthcare
of PWD children in both study areas is quite low; therefore, it does not capture the true cost of health
care (i.e. cost compared to private health care facilities). Although low, it is still a significant portion of
their household income, at an average of around 15%. Among the types of disability, the mobility-
impaired in Mandaue City and development/psychosocial group in San Remigio have the highest
percentage share.
Figure 8. Average household income and health expenses of PWD children, by study area and type of
impairment
Source of basic data: PIDS-IDE PWD Survey, July 2016
0.00 5000.00 10000.00 15000.00 20000.00 25000.00 30000.00
MI
VI
HI
DPSI
Total
MI
VI
HI
DPSI
Total
MI
VI
HI
DPSI
Total
Man
dau
e C
ity
San
Rem
igio
All
Sit
es
Medicine Therapy Check-up Transportation
99.37
67.28 88.74
176.45
129.45
89.88
59.98
31.69 55.27
63.60
97.29
64.38
73.96
158.69
115.15
25.91
3.19
3.32 16.79
16.63
1.70
6.52
9.78 23.3
10.16
20.59
4.51
4.99 17.7
15.23
0.00
20.00
40.00
60.00
80.00
100.00
120.00
140.00
160.00
180.00
200.00
MI VI HI DPSI Total MI VI HI DPSI Total MI VI HI DPSI Total
Mandaue City San Remigio All Sites
Th
ou
san
ds
Household Income Health Expenses
Draft as of December 2017
In relation to the average cost of health care shown above, the lack of money is one of the major reasons
of PWD children who got sick for not visiting a health facility. An average annual healthcare
expenditure of PWD children of PHP 15,225.66 is a significantly huge burden for some of the PWD
households, particularly those who fall below the poverty line. [Poor] households often resort to self-
medication, especially if the illness experienced is just fever/common cold/cough. Some often prefer
traditional medications (e.g. herbal supplements, traditional healers), particularly in San Remigio.
Table 9. Percentage distribution of PWD children who got sick during the past 12 months, by reasons for not
going to a health facility, study area and type of impairment
Reasons for NOT visiting
health facility
Mandaue City
Mobility Visual Hearing Development/
Psychosocial Total
No money 0.0 0.0 33.3 33.3 22.0
Worried about the cost of
medication
0.0 0.0 33.3 0.0 5.5
Home remedy is available 100.0 0.0 100.0 33.3 58.8
No need/regular check only 0.0 0.0 33.3 0.0 5.5
Others 50.0 0.0 0.0 0.0 12.9
San Remigio
Mobility Visual Hearing
Development/
Psychosocial Total
Facility is far 9.1 0.0 0.0 0.0 5.1
No money 36.4 42.9 0.0 0.0 30.0
Does not want to be absent
from work
9.1 0.0 0.0 0.0 5.1
Home remedy is available 27.3 14.3 50.0 50.0 29.2
No need/regular check only 18.2 14.3 0.0 0.0 13.4
No companion to go to the
facility
9.1 0.0 0.0 0.0 5.1
Preference to traditional
healers
9.1 14.3 0.0 0.0 8.3
Others 18.2 14.3 50.0 0.0 19.1
All Sites
Mobility Visual Hearing
Development/
Psychosocial Total
Facility is far 5.2 0.0 0.0 0.0 1.9
No money 20.8 27.2 23.3 29.7 25.1
Worried about the cost of
medication
0.0 0.0 23.3 0.0 3.4
Does not want to be absent
from work
5.2 0.0 0.0 0.0 1.9
Home remedy is available 58.3 9.1 84.9 35.2 47.5
No need/regular check only 10.4 9.1 23.3 0.0 8.5
No companion to go to the
facility
5.2 0.0 0.0 0.0 1.9
Preference to traditional
healers
5.2 9.1 0.0 0.0 3.2
Others 31.8 9.1 15.1 0.0 15.3 Source of basic data: PIDS-IDE PWD Survey, July 2016
3.2 Adult Women with Disabilities
Majority of adult women respondents in both study areas belong to the mobility group (49.2% in
Mandaue City; 35.6% in San Remigio). In terms of specific medical conditions, the leading conditions
among the mobility impaired are polio (38.5% in Mandaue City; 25.0% in San Remigio) and stroke
(23.1% in Mandaue City; 18.7% in San Remigio). Almost all of those with polio had paralysis and/or
muscle weakness, mostly on the legs (right leg in Mandaue City and left leg in San Remigio). There
Draft as of December 2017
were also respondents who have experienced post-polio syndrome (20% in Mandaue City; 50% in San
Remigio). Meanwhile, all respondents with stroke have their legs affected by the condition; some of
which also have affected arms/hands. Moreover, all of those with stroke in Mandaue City had
difficulties in movement with some also experiencing speech difficulties. In San Remigio, many had
difficulty in either thinking (e.g. memory), emotions and/or speech.
There were also a significant proportion of respondents with lower limb defects, either congenital or
amputated. Among those with congenital lower limb defect in Mandaue City, either a leg (below the
knee) or both lower legs were affected while in San Remigio, either a leg (above the knee) or both feet
were affected. Meanwhile, most of the respondents with lower limb amputation had an affected leg,
mostly below the knee in Mandaue City and above the knee in San Remigio.
For the visually impaired, majority are partially blind with optic nerve disease (in Manduae City and
San Remigio) and lens disease (in San Remigio) as the most common causes of visual impairment. On
the other hand, majority of the hearing impaired were partially deaf.
For those with development/psychosocial impairment, 57.5% have intellectual disability, 32.3% have
psychosocial disability, and 10.1% suffer from other conditions. The three most common causes, on the
average, are learning disabilities (i.e. slow learners), mental retardation, and toxic psychosis.
Table 10. Distribution of PWD adult women, by study area, type of impairment and specific conditions
Impairment/Condition Mandaue City San Remigio All Sites
N % N % N %
Mobility
Spinal cord injury 0 0.0 6 6.2 6 1.3
Cerebral palsy 29 7.7 0 0.0 29 6.1
Polio 143 38.5 25 25.0 168 35.7
Lower limb amputation 29 7.7 25 25.0 53 11.3
Congenital lower limb defect 57 15.4 12 12.5 69 14.8
Stroke 86 23.1 18 18.7 104 22.2
Other conditions 57 15.4 12 12.5 69 14.8
Visual
Partially blind 108 76.9 68 92.3 175 82.2
Totally blind 32 23.1 6 7.7 38 17.8
Hearing
Partially deaf 64 61.5 19 38.5 83 54.1
Totally deaf 40 38.5 31 61.5 71 45.9
Development/Psychosocial
Intellectual disability 102 72.7 10 18.2 112 57.5
Mental retardation 51 36.4 0 0.0 51 26.2
Down syndrome 0 0.0 5 9.1 5 2.5
Learning disabilities 64 45.5 0 0.0 64 32.8
Psychosocial disability 38 27.3 25 45.5 63 32.3
Schizophrenia 0 0.0 5 9.1 5 2.5
Disordered mood 25 18.2 5 9.1 30 15.6
Toxic psychosis 13 9.1 25 45.5 37 19.2
Neurotic/somatoform disorders 0 0.0 5 9.1 5 2.5
Other conditions 13 9.1 5 9.1 18 9.1
Other conditions 0 0.0 20 36.4 20 10.1 Source of basic data: PIDS-IDE PWD Survey, July 2016
In terms of highest educational attainment, majority of adult women respondents in both study areas
have attained at least elementary level of education. There is, unsurprisingly, a greater proportion of
respondents with post-secondary level of education (i.e. vocational, college or higher) in Mandaue City
(16%) than in San Remigio (11.2%). In terms of type of impairment, the hearing-impaired in Mandaue
City and the mobility-impaired in San Remigio have the largest proportion of respondents who have
Draft as of December 2017
attained high-school level or higher. It is interesting to note that 9.1% of the development/psychosocial
group in San Remigio have attained a tertiary level of education. Those respondents were on their 30s,
and probably were already in college, before the impairment (schizophrenia) was observed.
Figure 9. Percentage distribution of PWD adult women, by educational attainment, study area and type of
impairment
Source of basic data: PIDS-IDE PWD Survey, July 2016
In terms of employment status, about 29.3% of adult women respondents were engaged in an income
generating activity. In both study areas, those with hearing or mobility impairment have higher
proportions compared to those with visual or development/psychosocial disabilities. Common income
generating activities in both study areas are running a store and street vending. Other cited jobs are
farming (particularly in San Remigio), and working at a factory or a household (particularly in Mandaue
City).
Table 11. Percentage distribution of PWD adult women who are engaged in an income generating activity, by
study area and type of impairment
Impairment Mandaue City San Remigio Total
Mobility 23.1 43.8 27.4
Visual 15.4 30.8 20.7
Hearing 61.5 76.9 66.5
Development/Psychosocial 9.1 27.3 14.2
Total 24.4 43.1 29.3 Source of basic data: PIDS-IDE PWD Survey, July 2016
Access to health services
Around three-fourths of adult women with disabilities in San Remigio got sick during the past 12
months from the date of interview. This is significantly higher compared to Mandaue City’s 49.7%.
Also, adult women with visual impairment have the highest proportion of getting sick among the four
types of impairment. However, only a small percentage of those who got sick (an average of 7.1%) have
access to PhilHealth.
15.47.7
30.827.3
18.3
7.7
23.127.3
11.6 12.27.7
28.3 27.3
16.5
9.1
1.8
2.5
0.5
61.5
30.8
72.7
49.4
43.8
53.8
53.8 27.3
45.0
57.8
38.7
17.4
60.0
48.3
7.7
38.5
38.5
16.2
37.5
38.5 7.727.3
30.413.9
38.5
28.5
7.6
20.0
7.7
7.7
4.86.2
7.73.6
7.4
7.7
4.5
7.7
23.1 23.1
11.2 12.57.7 9.1 7.6 8.7
15.2 18.1
2.510.3
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
MI VI HI DPSI Total MI VI HI DPSI Total MI VI HI DPSI Total
Mandaue City San Remigio All Sites
No formal education Preschool Elementary High School Vocational College or higher
Draft as of December 2017
Figure 10. Percentage distribution of PWD adult women who got sick within the past 12 months and who are
covered by PhilHealth, by study area and type of impairment
Source of basic data: PIDS-IDE PWD Survey, July 2016
Common coughs, cold, flu, and fever are the most common cause of sickness among adult women who
got sick in both study areas. It is also worth noting that there are adult women who have experienced
PWD-related diseases (6.3% in Mandaue City; 10.6% in San Remigio). Other illnesses and medical
conditions mentioned by the respondents were hyperacidity, miscarriage, chest pains, and urinary tract
infection, among others.
Figure 11. Percentage distribution of PWD adult women who got sick during the past 12 months, by type of
illness, study area and type of impairment
Source of basic data: PIDS-IDE PWD Survey, July 2016
Both study areas have an average of 3 out of 5 adult women who got sick have visited a health facility.
This is unlike the case of PWD children wherein there is a higher proportion of respondents in Mandaue
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
MI VI HI DPSI Total MI VI HI DPSI Total MI VI HI DPSI Total
Mandaue City San Remigio All Sites
Got sick With PhilHealth
33.3
6.4 7.1
10.0
6.0
2.7 3.7
23.4
6.2
60.0
77.8
55.6
60.0 6
3.7
85.7
80.0
87.5
100.0
86.1
69.6
78.6
65.1
71.2
71.5
20.0
11.1
20.0
13.1
14.3
12.5
20.0
10.6
17.9
11.5
20.0
12.3
11.1
20.0
6.3
14.3
12.5
20.0
10.6
5.4 7
.0
3.7
20.0
7.8
20.0
44.4
11.1
21.2
7.1
10.0 12.5
20.0
10.4
15.2
31.8
11.5
5.6
17.5
0
10
20
30
40
50
60
70
80
90
100
MI VI HI DPSI Total MI VI HI DPSI Total MI VI HI DPSI Total
Mandaue City San Remigio All Sites
Common non-communicable diseases Common coughs, cold, flu, fever Injury, cut, wound, burn PWD-related diseases Others
Draft as of December 2017
City who went to a health facility within a year. By type of impairment, the hearing-impaired in
Mandaue City and the mobility-impaired in San Remigio mostly visited a health facility.
Table 11. Percentage distribution of PWD adult women who got sick during the past 12 months and have visited
a health facility, by study area and type of impairment Disability Mandaue City San Remigio Total
Mobility 60.0 71.4 64.3
Visual 44.4 40.0 42.8
Hearing 66.7 62.5 65.4
Development/Psychosocial 60.0 40.0 54.4
Total 57.3 57.2 57.2 Source of basic data: PIDS-IDE PWD Survey, July 2016
Rural Health Units (RHUs) and municipal health centers (37.9%) were the most common types of health
facility visited by adult women in both study areas. In Mandaue City, respondents have a wide variety
of choices of health facilities. This is evident by the relatively equal proportions of respondents per type
of health facility. On the other hand, in San Remigio, there is a greater proportion of respondents going
to RHUs and barangay health centers, signifying a lack of options and/or a greater preference to health
facilities within their physical accessibility.
Table 12. Percentage distribution of PWD children respondents who got sick during the past 12 months, by type
of health facility visited, study area and type of impairment
Type of Health Facility Visited
Mandaue City
Mobility Visual Hearing Development/
Psychosocial Total
Public District Hospital 66.7 25.0 0.0 0.0 31.6
Municipal/City Hospital 33.3 0.0 16.7 0.0 17.0
RHU/Health Center 33.3 0.0 33.3 0.0 20.7
Barangay Health Center 0.0 0.0 33.3 66.7 19.3
Private Hospital 0.0 25.0 33.3 0.0 12.4
Private Clinic 0.0 25.0 16.7 33.3 14.6
Others 0.0 50.0 0.0 0.0 10.0
San Remigio
Mobility Visual Hearing
Development/
Psychosocial Total
Public Provincial Hospital 10.0 0.0 0.0 0.0 5.4
Municipal/City Hospital 10.0 0.0 0.0 0.0 5.4
RHU/Health Center 60.0 100.0 80.0 50.0 70.5
Barangay Health Center 50.0 50.0 0.0 100.0 45.9
Private Hospital 0.0 0.0 20.0 50.0 7.8
All Sites
Mobility Visual Hearing
Development/
Psychosocial Total
Public Provincial Hospital 4.2 0.0 0.0 0.0 1.9
Public District Hospital 38.9 16.4 0.0 0.0 20.7
Municipal/City Hospital 23.6 0.0 11.9 0.0 13.0
RHU/Health Center 44.4 34.3 46.6 10.3 37.9
Barangay Health Center 20.8 17.2 23.8 73.5 28.4
Private Hospital 0.0 16.4 29.5 10.3 10.8
Private Clinic 0.0 16.4 11.9 26.5 9.6
Others 0.0 32.8 0.0 0.0 6.6 Source of basic data: PIDS-IDE PWD Survey, July 2016
On the average, adult women in San Remigio travel longer distances compared to those in Mandaue
City. This is again due to the greater concentration of health facilities in the city. By type of disability,
those with mobility impairment in both study areas travel the farthest to visit a health facility (public
provincial hospital) mainly due to PWD-related diseases.
Draft as of December 2017
Table 13. Distance of the nearest health facility visited by PWD adult women who got sick during the past 12
months, by study area and type of impairment (in kilometers)
Disability Mandaue City San Remigio Total
Mobility 6.07 10.23 7.80
Visual 5.38 4.58 5.10
Hearing 1.23 5.06 2.32
Development/Psychosocial 0.38 1.05 0.52
Total 3.84 7.42 5.07 Source of basic data: PIDS-IDE PWD Survey, July 2016
Despite longer distances, adult women in San Remigio went to health facilities more frequently than
those in Mandaue City. Among the four disabilities, respondents with hearing impairment in Mandaue
City and adult women with development/psychosocial mostly visited a health facility. The high average
of visit for the development/psychosocial group in San Remigio is due to a respondent with
arteriosclerosis who visits a barangay health center every week to monitor her blood pressure and for
maintenance medicines.4 Table 14. Frequency of visit to a health facility by PWD adult women who got sick during the past 12 months, by
study area and type of impairment
Disability Mandaue City San Remigio Total
Mobility 1.3 2.7 1.9
Visual 2.3 5.0 3.2
Hearing 4.7 6.8 5.3
Development/Psychosocial 2.0 28.5 7.4
Total 2.4 6.1 3.7 Source of basic data: PIDS-IDE PWD Survey, July 2016
Similar to the case of PWD children, medicines took up the largest share of medical expenses incurred
by adult women with disabilities in both study areas. Regardless of the type of illness experienced
within the reference period, cost of medicines is on the average at 70% of the total healthcare
expenditure. Among the types of disability, those with development/psychosocial disability (in San
Remigio) and mobility impairment (in both study areas) incur the highest cost on medicine. It is worth
noting that the development/psychosocial group in Mandaue City has incurred zero cost on medicines.
This is probably because none of them are taking maintenance medication (i.e. mind drugs). Meanwhile,
transportation takes up around 25%, on the average, of the total healthcare expenditure. Costs for
therapy and check-up is minimal, at less than 10%, since majority of the respondents go to public health
facilities. Overall, healthcare expenditure of adult women, on the average, is equivalent to around 50%
of the average personal income of the PWD adult women or about 10% of the total household income.
4 Excluding the outlier, the average frequency of visit of respondents with development/psychosocial impairment
in San Remigio will be 5.0.
Draft as of December 2017
Figure 12. Health expenses of PWD adult women during the past 12 months, by study area and type of impairment
(in pesos)
Figure 13. Average household income, personal income and health expenses of PWD adult women, by study
area and type of impairment
Source of basic data: PIDS-IDE PWD Survey, July 2016
For those who did not visit a health facility, majority of adult women in both study areas rely on home
remedies. This is particularly true for those who only had common colds, cough, flu, fever, and, in some
instances, hyperacidity and UTI. There is also a case in San Remigio that a respondent does not go to a
0.00 5,000.00 10,000.00 15,000.00 20,000.00 25,000.00
MI
VI
HI
DPSI
Total
MI
VI
HI
DPSI
Total
MI
VI
HI
DPSI
Total
Man
dau
e C
ity
San
Rem
igio
All
Sit
es
Medicine Therapy Check-up Transportation
0.00
50.00
100.00
150.00
200.00
250.00
MI VI HI DPSI Total MI VI HI DPSI Total MI VI HI DPSI Total
Mandaue City San Remigio All Sites
Tho
usa
nd
s
Household Income Personal Income Health Expenses
Draft as of December 2017
health facility because she was frequently visited by their Barangay Health Worker (BHW). Other
reasons mentioned by the respondents were shyness and not comfortable in going to a health facility.
Table 15. Percentage distribution of PWD children who got sick during the past 12 months, by reasons for not
going to a health facility, study area and type of impairment
Reasons for NOT visiting health
facility
Mandaue City
Mobility Visual Hearing Development/
Psychosocial Total
Facility is far 50.0 0.0 0.0 0.0 17.8
No money 0.0 20.0 0.0 0.0 6.7
Home remedy is available 50.0 40.0 66.7 50.0 49.1
Preference to traditional healers 0.0 0.0 33.3 0.0 5.0
Others 50.0 0.0 33.3 0.0 22.8
San Remigio
Mobility Visual Hearing
Development/
Psychosocial Total
No money 0.0 16.7 0.0 0.0 6.7
Worried about the cost of medication 0.0 16.7 0.0 0.0 6.7
Home remedy is available 50.0 50.0 33.3 100.0 56.5
No need/regular check only 0.0 16.7 0.0 33.3 12.5
Not comfortable going to a health
facility
0.0 0.0 33.3 0.0 4.5
Others 50.0 16.7 66.7 0.0 30.2
All Sites
Mobility Visual Hearing
Development/
Psychosocial Total
Facility is far 35.0 0.0 0.0 0.0 11.7
No money 0.0 18.7 0.0 0.0 6.7
Worried about the cost of medication 0.0 6.4 0.0 0.0 2.3
Home remedy is available 50.0 43.9 55.9 68.4 51.7
No need/regular check only 0.0 6.4 0.0 12.2 4.3
Not comfortable going to a health
facility
0.0 0.0 10.8 0.0 1.6
Preference to traditional healers 0.0 0.0 22.5 0.0 3.3
Others 50.0 6.4 44.1 0.0 25.4 Source of basic data: PIDS-IDE PWD Survey, July 2016
4. Summary and Conclusion
Findings from this study highlight the lack of access to appropriate services for individuals with
disabilities. Needed services for individuals with disabilities include evaluation and diagnostic testing,
treatment and pharmacologic management, availability of trained health care providers and specialists,
and access to clinic facilities within a reasonable distance.
Delays in development, which includes a child’s language, motor, cognitive and social skills, should
ideally be monitored during routine child health examinations with their pediatrician, with the focus of
assessing whether the child is meeting his/ her developmental milestones. Early identification of a
disability can lead to early intervention services. Studies have supported improved language and
communication skills in those who are deaf and hard of hearing that received early intervention services
(Moeller, 2000). Similarly, early intervention services in those with autism demonstrated improvement
in their cognitive, language and social development including gains in their functional skills (Remington
et al., 2007), (Eikeseth, Klintwall, Jahr, & Karlsson, 2012). While the cost of early detection and
intervention programs can be expensive, studies have found an overall positive economic return over
the span of individual’s life (Cidav et al., 2017).
Unfortunately, many children are brought to medical attention for urgent or sick consultations wherein
the focus would be on the presenting illness such as a cough or ear infection, rather than their overall
Draft as of December 2017
development. Routine assessment of the child’s developmental milestones allows the medical provider
to identify delays early on and make appropriate treatment recommendations. Early intervention during
childhood leads to immediate and sustained benefits for both the child and the family (Karoly, Kilburn,
& Cannon, 2005). Continued efforts to promote routine monitoring of development and early detection
is needed.
PhilHealth presently provides coverage for newborn screening, which detects certain genetic, metabolic
and endocrine related disorders that can potentially result in death and disability if not addressed early
on during the infancy period. PhilHealth also covers the newborn hearing screen to allow for early
detection and intervention services for those who are hearing impaired. However, the hearing tests
conducted in the newborn period only detects congenital hearing loss (i.e. hearing loss present at birth).
Periodic routine hearing and vision screens during the early childhood period are recommended so as
to detect conditions not present at the time of birth, such as hearing loss resulting from frequent ear
infections. A strategy that allows for a large proportion of children to be evaluated is to embed these
screenings in the school setting, such as when children enter the first grade. This strategy is strongly
deployed in the US, where a majority of states have implemented these routine screenings. Presently,
San Remigio receives auxiliary medical services through their affiliation with a local medical school.
This is beneficial to the community as they are able to access increased medical services in their area
while simultaneously providing the medical students with increased clinical exposure and experience
in a community setting. Expanded utilization of the medical and nursing students in these communities
in providing preventive care services can be accomplished through conducting routine vision and
hearing screenings in the school setting.
Healthcare, transportation and housing have been found to contribute to the additional costs of those
with disabilities (Dumais, Prohet, & Ducharme, 2015). The proposed PhilHealth expansion for children
with disabilities aims to provide coverage for habilitative/rehabilitative therapy services. Despite
increased coverage, the physical access to therapy services in regards to distance to the facility and cost
and availability of transportation, as well as access to therapy providers (physical therapists, speech
therapists and occupational therapists) remain barriers to care and treatment. Strengthening and
broadening the relationship with academic health institutions by extending beyond medical and nursing
students to reach the allied health tracks may allow for auxiliary therapy services to be provided by
students in the fields of physical therapy, speech therapy and occupational therapy.
In addition to access to therapists, access to physicians trained in the complex care of PWDs continues
to be a significant barrier to care. It is estimated that 40–50% of individuals with autism in the US
receive at least one psychotropic medication (Weeden, Ehrhardt, & Poling, 2010). With the significant
number of individuals who require medications for their disability, it is important to provide training
for local medical providers on the pharmacologic interventions for various disabilities as well as support
in the management of behavioral and mental health conditions. During the survey, one of the physicians
reported that he is unable to prescribe certain medications due to the cost-prohibitive nature of acquiring
and maintaining an S2 license. The S2 license allows a doctor to prescribe certain narcotics and
psychotropic medications, some of which are required in the care of PWDs. Included in this list are
medications such as diazepam, which can be administered when the patient has a breakthrough seizure
lasting several minutes. Increased training on the use of psychotropic medications and improved
coverage for licensures/ prescription coverage is needed. Furthermore, when PWDs are prescribed
medications, these medications are generally taken as a chronic/ maintenance medication. The daily
cost of medications, which are often more than one medication being prescribed, leads to increased
health care related expenditures for these individuals. PWDs may also have limitations with their
activities of daily living, and the need for an aide or full-time caregiver to assist with their needs poses
even greater costs. Expanded coverage to cover for medications as well as nursing/ caregiver support
would be beneficial for PWDs, particularly for those who have more significant limitations.
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